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perinatal outcomes of frozen-thawed embryo transfer following blastocyst-stage embryo transfer compared to those of cleavage-stage embryo transfer: analysis of 9408 singleton newborns using propensity score analysis

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生殖与发育医学(英文) 2024年第2期8卷 67-74页

作者： Zhong Hu-Cen Wan Qi Hu Yu-Ling Li Tian Huang Li-Juan Wang Mao Hu Xin-Yue Wang Meng-Di Zhong Zhao-Hui School of Public Health Joint International Research Laboratory of Reproduction and Development of the Ministry of Education of China Chongqing China Department of Obstetrics and Gynecology West China Second Hospital Sichuan University Chengdu China Sichuan Jinxin Xinan Women and Children’s Hospital Chengdu Sichuan China Department of Reproductive Medicine the First Affiliated Hospital of Chongqing Medical University Chongqing China School of Public Health Research Center for Medical and Social Development Chongqing Medical University Chongqing China

Objective: Regarding frozen-thawed embryo transfer (FET), there is limited consensus on whether extending embryo culture from the cleavage stage to the blastocyst stage affects perinatal outcomes. This study aimed to compare perinatal outcomes of singletons between blastocyst-stage embryo transfer (BT) and cleavage-stage embryo transfer (CT) in FET.Methods: A total of 9408 FET cycles that met the inclusion criteria were included in this retrospective cohort study between 2019 and 2022. Blastocyst-stage embryo transfers were performed in the BT group, and cleavage-stage embryo transfers were performed in the CT group. Multivariate logistic regression analyses were performed, as well as propensity score matching (PSM) to adjust for confounders.Results: After PSM, a higher risk of pre-term birth (PTB; odds ratio [OR]: 1.23, 95% confidence interval [CI]: 1.00-1.50,P = 0.048) and being large for gestational age (LGA;OR: 1.16, 95%CI: 1.00-1.35,P = 0.050) was observed in the BT group compared to that in the CT group. After stratified PSM, in the subgroup under 35 years of age, only an increased risk of LGA was observed in the BT group compared to the CT group. perinatal outcomes in the double-embryo transfer subgroup were similar to those in the unstratified group. However, in the subgroup beyond 35 years of age and the single embryo transfer subgroup, perinatal outcomes were not statistically different between the BT and CT groups (P >0.05).Conclusions: In FET, prolonged embryo culture to the blastocyst stage increased the risk of PTB and LGA in single fetuses. However, stratified analysis based on age and the number of transferred embryos yielded different results, necessitating further mechanistic studies.

关键词： Frozen-thawed embryo transfer Blastocyst Cleavage stage perinatal outcomes Pre-term birth Large for gestational age Small for gestational age

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Impacts of assisted reproductive technology on perinatal outcomes and offspring health

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Reproductive and Developmental Medicine 2023年第1期7卷 56-63页

作者： Hong Jin Yi-Juan Sun Yi-Min Shu Department of Ministry of Education-Shanghai Key Laboratory of Children’s Environmental Health Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of MedicineNo.1665 Kongjiang RoadShanghai 200092China Department of Genetics and IVF Shanghai Ji Ai Genetics and IVF InstituteObstetrics and Gynecology HospitalFudan UniversityShanghai 200011China Division of Reproductive Endocrinology and Infertility Women and Infants Hospital/The Warren Alpert Medical School of Brown UniversityRI 02903USA

Assisted reproductive technology(ART)has evolved rapidly over the last 40 years,offering hope to individuals and couples struggling with infertility.As technology continues to evolve,simulating a realistic female reproductive system environment has become a common goal for all types of ARTs,thereby reducing the impact of the artificial microenvironment on perinatal and offspring health.In this review,we provide a brief history of the development of each major ART and discuss the impact of ART on perinatal and offspring health.We also explore how the negative consequences of ART may be overcome and how its benefits can be maximized.

关键词： Assisted reproductive technology perinatal outcomes Offspring health

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Evaluation of perinatal and Developmental outcomes in Neonates with Abstinence Syndrome Admitted to NICU

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International Journal of Mental Health Promotion 2023年第2期25卷 265-274页

作者： Ali Kheradmand Sahar Ashrafzadeh Farzane Rouzegari Samin Aliakbarian Ali Naseh Department of Psychiatry Shahid-Beheshti University of Medical SciencesTehran19839-63113Iran David Geffen School of Medicine University of CaliforniaLos AngelesCA90095USA Shahid-Beheshti University of Medical Sciences Tehran19839-63113Iran Department of Pediatrics Clinical Research Development CenterMahdiyeh Educational HospitalShahid-Beheshti University of Medical SciencesTehran19839-63113Iran

Drug abuse by pregnant women is one of the significant problems for mothers and their neonates.This study aimed to investigate the effects of maternal substance use disorder during pregnancy on neonatal developmental criteria.In a case-control study,clinical records of 90 neonates diagnosed with neonatal abstinence syndrome who were admitted to NICU in one of four hospitals affiliated with Shahid-Beheshti University of Medical Sciences in Tehran,Iran between 2017 and 2020 were compared to 90 neonates without neonatal abstinence syndrome(control group).Demographic information and data for neonatal developmental characteristics and complications were extracted from the clinical records of this convenience sample.Data for the type and method of maternal substance use during pregnancy were collected through a telephone call with mothers.Our data showed that the prevalence of drug addiction was 1.8%among pregnant women,and the most common drugs used by mothers were opium(n=45%,50%),amphetamine(n=30%,33%),and methadone(n=14%,16%).Neonates with abstinence syndrome had a higher prevalence of transient tachypnea of the newborn(TTN)(P=0.004),and a prevalence of being admitted to NICU(P=0.05)and for a longer duration(P<0.001).Their mothers had a higher prevalence of having pre-eclampsia(P=0.010).Using morphine vs.amphetamine showed no difference based on their effects on mothers and neonates.Substance use during pregnancy increased the prevalence of pregnancy complications(pre-eclampsia)and neonatal complications(TTN and prevalence and duration of hospitalization).Therefore,planning for the development of health policies to raise awareness among women and more broadly,all members of the community,is important to prevent the tendency to engage in this potentially high-risk behavior.

关键词： Drug abuse maternal addiction substance use disorder neonatal abstinence syndrome developmental characteristics perinatal outcomes case-control study neonates pregnancy

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Long interpregnancy interval and adverse perinatal outcomes: a retrospective cohort study

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Science China(Life Sciences) 2020年第6期63卷 898-904页

作者： Jing Lin Han Liu Dan-Dan Wu Hong-Tao Hu Hui-Hui Wang Cheng-Liang Zhou Xin-Mei Liu Xiao-Jun Chen Jian-Zhong Sheng He-Feng Huang International Peace Maternity and Child Health Hospital School of MedicineShanghai Jiao Tong UniversityShanghai 200030China Institute of Embryo-Fetal Original Adult Disease Shanghai Key Laboratory for Reproductive MedicineSchool of MedicineShanghai Jiao Tong UniversityShanghai 200030China Shanghai Key Laboratory of Embryo Original Disease Shanghai 200030China Department of Pathology and Pathophysiology School of MedicineZhejiang UniversityHangzhou 310058China

We conducted a retrospective cohort study of 9,552 women experiencing their second delivery between 2014 and 2016 at the International Peace Maternity and Child Health Hospital to investigate the association between the interpregnancy interval(IPI)and adverse perinatal outcomes. With the 12–23-mon IPI as the reference category, logistic regression analyzes were used to examine associations between different IPIs(perinatal outcomes(gestational diabetes mellitus, premature membrane rupture, gestational hypertension, preterm birth, low birth weight, and macrosomia).Compared with the 12–23-mon IPI category, women with longer IPIs had a higher risk of adverse perinatal outcomes, and those with an IPI ≥120 mon had the highest risk of gestational diabetes mellitus and premature membrane rupture(adjusted odds ratio(OR) 1.76, 95% confidence interval(CI) 1.32–2.35 and adjusted OR 2.03, 95% CI 1.53–2.67, respectively). These results indicate that a longer IPI is associated with a higher risk of adverse perinatal outcomes and an IPI of ≥120 mon appears to be independently associated with a higher risk of gestational diabetes mellitus and premature membrane rupture.

关键词： interpregnancy interval perinatal outcomes gestational diabetes mellitus premature membrane rupture

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Predictive Value of Amniotic Fluid Index in Term Small for Gestational Age with Normal Doppler Studies for perinatal outcomes

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Open Journal of Obstetrics and Gynecology 2023年第8期13卷 1339-1349页

作者： Rajakarunage Madhuka Udantha Rajakaruna Samarathunga Madhava Gananatha Karunaratne Brahmanamudhiyanselage Nimesha Sajeewani Thennakoon Department of Obstetrics and Gynecology University of Sri Jayewardenepura Nugegoda Sri Lanka

Background and Aim: Delivery of a fetus with SGA is associated with increased risk of perinatal morbidity and mortality. Evidence is limited for the accuracy of Oligohydramnios to predict substantive perinatal morbidity and mortality in non–anomalous SGA fetuses monitored with normal Doppler studies. The aim of this study is to determine the association between amniotic fluid index and adverse perinatal outcomes in term SGA fetuses with normal Doppler studies. Method: This is a prospective observational study carried out by 340 pregnant women who were admitted to obstetrics unit, Sri Jayewardenepura from January 2019 to January 2023. Singleton pregnancies at term who were diagnosed with SGA (EFW 10th centile or AC 10th centile) with normal umbilical artery and middle cerebral artery Doppler studies were included. AFI was assessed predelivery and data were collected according to demographic details, mode of delivery, time of delivery, intrapartum events, and neonatal outcomes. Results: A total of 340 term pregnant women were studied. Out of them, 44% were in AFI more than 10 groups and 37% and 19% were in AFI 5 - 10 and less than 5 groups respectively. More obstetrics interventions were reported in AFI 5 groupa in terms of induction of labor (P 0.04) and emergency caesarean sections (P 0.003). No significant deference in immediate neonatal outcome was detected between each group. (Meconium-stained liquor (P 0.634), 1 minute APGAR (P 0.575) and 5-minute APGAR P 0.165)). Neonatal unit admission (P 0.001) and long-term neonatal complications were

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perinatal Management and outcomes of Pregnancy Following Sheehan Syndrome: A Case Report and Literature Review

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Maternal-Fetal Medicine 2021年第3期3卷 213-220页

作者： Yongchi Zhan Tingting Xu Xiaodong Wang Department of Obstetrics and Gynecology West China Second University HospitalSichuan UniversityChengduSichuan 610041China Key Laboratory of Birth Defects and Related Diseases of Women and Children(Sichuan University) Ministry of EducationChengduSichuan 610041China

Pregnancy is rare and difficult in Sheehan syndrome patients.With the help of assisted reproductive technology,the patients even with panhypopituitarism can get pregnant again.Moreover,women with hypopituitarism have increased risk of pregnancy complications.Here we report a patient who suffered acute and severe Sheehan syndrome with panhypopituitarism and central diabetes insipidus got pregnant again by in vitro fertilization and embryo transfer.A regular and careful antenatal care was given by the cooperation between obstetricians and endocrinologists.Finally,she delivered a healthy female baby at 37+6 weeks of gestation with Apgar scores of 10 and 10 at 1 and 5 minutes,respectively.The patient and her baby were doing well at postpartum follow-up.The related articles were also reviewed.This case report is aimed to help clinical practitioners to make better decisions on the management of Sheehan syndrome or other type of hypopituitarism during pregnancy.

关键词： perinatal care perinatal outcomes Sheehan syndrome Subsequent pregnancy

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Comparison of perinatal outcomes in Late Preterm Spontaneous and Indicated Preterm Birth Neonates

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Open Journal of Obstetrics and Gynecology 2016年第12期6卷 661-668页

作者： Dasom Chun Eun Hye Yoo Ji Young Lee Hyun Mi Kim Mi Ju Kim Won Joon Seong Hyun-Hwa Cha Department of Obstetrics and Gynecology Kyungpook National University Hospital Kyungpook National University School of Medicine Daegu Korea

Objective: We aimed to compare the perinatal outcomes in late preterm spontaneous and indicated birth neonates. Methods: We studied 289 late preterm births, classified as either aspontaneous late preterm birth (sLPTB) group (preterm labor with intact membranes and preterm premature rupture of membranes) or an indicated late preterm birth (iLPTB) group (hypertensive disorder in pregnancy, placental causes, and maternal diseases), according to the delivery indication. We then compared the maternal and neonatal characteristics and perinatal outcomes, including the Apgar score, admission to the neonatal intensive care unit (NICU) or special care nursery (SCN), duration of NICU stay, and the rate of composite morbidity (antibiotic use, hypoglycemia, hypocalcemia, hyperbilirubinemia requiring phototherapy, respiratory support, and respiratory distress syndrome). Results: A total of 198 neonates were in the sLPTB group and 91 were in the iLPTB group. In spite of greater gestational age at the time of delivery in the iLPTB group, the mean birth weight was lower than that in the sLPTB group. Additionally, the iLPTB group showed lower Apgar scores, and higher rates of NICU or SCN admission, respiratory support, and hypoglycemia, but there was no difference in the rate of composite morbidity between the two groups. Conclusion: iLPTB neonates had lower birth weights despite greater gestational age than those in the sLPTB group, but there was no difference in the rate of composite morbidity between the two groups.

关键词： Composite Morbidity Indicated Preterm Birth Late Preterm Birth perinatal outcomes Spontaneous Preterm Birth

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A Comparison of Amniotic Fluid Index versus Single Deepest Vertical Pocket Measurement at Term as a Predictor of Adverse perinatal Outcome

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Open Journal of Obstetrics and Gynecology 2022年第10期12卷 1062-1078页

作者： Hasitha Gunasingha Sardha Hemapriya Sachini Mendis Department of Obstetrics Teaching Hospital Kandy Sri Lanka

Introduction: Oligohydramnios is an important sign of fetal jeopardy and amniotic fluid index (AFI) and single deepest vertical pocket (SDVP) have been used to detect it. Objective: To compare AFI vs. SDVP at term as a predictor of adverse perinatal outcomes. Methods: A prospective observational study was conducted in Teaching Hospital Kandy, Sri Lanka for eight months from July 2015 to March 2016. 448 Singleton pregnancies admitted after 37 completed weeks were included. AFI ≤ 5 cm and SDVP perinatal outcomes. Conclusion: AFI better predicted oligohydramnios and subsequent labour induction than SDVP. Low SDVP was a risk factor for adverse perinatal outcomes (such as induction of labour, meconium-stained liquor, operative delivery, 5-minute Apgar less perinatal deaths). In predicting adverse perinatal events, a higher potential was noted in SDVP method than AFI method. To determine the most predictive cut-off values of SDVP and AFI for each perinatal outcome, an in-depth experimental analysis is required in future research.

关键词： perinatal outcomes Amniotic Fluid Predictability AFI SDVP

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Obstetrical Disease Spectrum in China： An Epidemiological Study of 111,767 Cases in 2011

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Chinese Medical Journal 2015年第9期128卷 1137-1146页

作者： Xiao-Lin Luo Wei-Yuan Zhang Department of Obstetrics Beijing Obstetrics and Gynecology Hospital Capital Medical University Beijing 100026 China

Background：No national research on maternal and fetal complications and outcomes has been carried out in the mainland of China in recent years.This study was to provide a scientific basis for better control of obstetrical and neonatal diseases and better allocation of medical resources by analyzing the epidemiological characteristics of obstetrical diseases in the mainland of China.Methods：Hospitalized obstetrical cases from 19 tertiary and 20 secondary hospitals in 14 provinces （nationally representative） during the period January 1,2011 to December 31,2011 were randomly selected.The general condition,pregnancy complications,and perinatal outcomes of the patients were studied.Results：The top five medical and surgical complications of pregnant women in the mainland of China were anemia （6.34％）,uterine fibroids （2.69％）,thyroid disease （1.11％）,thrombocytopenia （0.59％）,and heart disease （0.59％）.The incidences of premature rupture of membranes （PROM）,preterm birth,prolonged pregnancy,hypertensive disorders complicating pregnancy （HDCP）,multiple pregnancy,intrahepatic cholestasis of pregnancy （ICP）,placenta previa,placental abruption,postpartum hemorrhage,and amniotic fluid embolism were 15.27％,7.04％,6.71％,5.35％,1.57％,1.22％,1.14％,0.54％,3.26％ and 0.06％,respectively.The incidences of anemia and prolonged pregnancy were significantly lower in tertiary than secondary hospitals （P ＜ 0.001）,whereas the incidence of uterine fibroids,thyroid diseases,thrombocytopenia,heart disease,PROM,preterm birth,HDCP,multiple pregnancy,ICP,placenta previa,and placental abruption were significantly higher in tertiary than secondary hospitals （P ＜ 0.001）.The cesarean section （CS） rate was 54.77％.The newborn sex ratio was 119：100,and 1.03％ of the neonates were malformed.The percentages of low birth weight and fetal macrosomia in full-term babies were 2.10％ and 7.09％,respectively.Conclusions：The incidence of some obstetrical diseases is still high in the mainland of China.The CS rate is much higher than World Health Organization recommendatio

关键词： Disease Spectrum perinatal outcomes Pregnancy Complications

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Cesarean section does not affect neonatal outcomes of pregnancies complicated with preterm premature rupture of membranes

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Chinese Medical Journal 2020年第1期133卷 25-32页

作者： Hai-Li Jiang Chang Lu Xiao-Xin Wang Xin Wang Wei-Yuan Zhang Department of Obstetrics Beijing Obstetrics and Gynecology HospitalCapital Medical UniversityBeijing 100026China

Background:Preterm premature rupture of membranes(PPROM)is associated with high neonatal morbidity and mortality.However,the influences of cesarean section(CS)on neonatal outcomes in preterm pregnancies complicated with PPROM are not well elucidated.The aim of this study was to investigate the influence of delivery modes on neonatal outcomes among pregnant women with PPROM.Methods:A retrospective cross-sectional study was conducted in 39 public hospitals in 14 cities in the mainland of China from January 1st,2011 to December 31st,2011.A total of 2756 singleton pregnancies complicated with PPROM were included.Adverse neonatal outcomes including early neonatal death,birth asphyxia,respiratory distress syndrome(RDS),pneumonia,infection,birth trauma,and 5-min/10-min Apgar scores were obtained from the hospital records.Binary variables and ordinal variables were respectively calculated by binary logistic regressions and ordinal regression.Numerical variables were compared by multiple linear regressions.Results:In total,2756 newborns were involved in the analysis.Among them,1166 newborns(42.31%)were delivered by CS and 1590 newborns belonged to vaginal delivery(VD)group.The CS proportion of PPROM obviously increased with the increase of gestational age(x2=5.014,P=0.025).Compared with CS group,VD was associated with a higher risk of total newborns mortality(odds ratio[OR],2.38;95%confidence interval[Cl],1.102-5.118;P=0.027),and a lower level of pneumonia(OR,0.32;95%Cl,0.126-0.811;P=0.016).However,after multivariable adjustment and stratification for gestational age,only pneumonia was significantly related with CS in 28 to 34 weeks group(OR,0.34;95%Cl,0.120-0.940;P=0.038).There were no differences regarding to other adverse outcomes in the two groups,including neonatal mortality,birth asphyxia,Apgar scores,RDS,pneumonia,and sepsis.Conclusions:The proportion of CS of pregnant women with PPROM was very high in China.The mode of delivery does not affect neonatal outcomes of pregnancies complicated with PPROM.

关键词： Preterm premature rupture of membranes Cesarean section Vaginal delivery perinatal outcomes

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